Massachusetts voters are considering an assisted suicide law. I do not deny the right of the states to create this type of legislation; better there than through federal law or mandate. I can be an American citizen and remain one while moving from a state whose laws I do not condone to a more legally congenial one. Call it freedom of choice. We like that phrase and use it often. That’s what proponents of assisted suicide legislation say, that we are giving people the freedom to make the choice. I’ll let those so inclined debate theological doctrine and the moral issue. I see nothing in scripture prohibiting suicide. Assisted suicide still looks like murder to me.
Ben Mattlin writes about this matter in the NYT, an op-ed, “Suicide by Choice? Not So Fast”. Disabled by spinal muscular atrophy from birth, it is a rare person so afflicted who lives so long. He wants to live longer. He’s nearly fifty years old, has a family and lives as a writer, although technically, he can no longer write. He sounds fairly helpless. “And a few years ago, when a surgical blunder put me into a coma from septic shock, the doctors seriously questioned whether it was worth trying to extend my life. My existence seemed pretty tenuous anyway, they figured. They didn’t know about my family, my career, my aspirations.” If his wife had not objected, he would not have been treated. He was in no position to protest. Doctors, looking at him objectively, are inclined to think his life is not worth living. He suffers and yet cherishes life. Maybe no one loves life like a person who has always lived close to death. Mattlin says, “I am more than my diagnosis and my prognosis.”
Aren’t we all? Yet he has this different perspective than most of us and writes about the coercion of the troublesomely ill by those who are well.
This is but one of many invisible forces of coercion. Others include that certain look of exhaustion in a loved one’s eyes, or the way nurses and friends sigh in your presence while you’re zoned out in a hospital bed. All these can cast a dangerous cloud of depression upon even the most cheery of optimists, a situation clinicians might misread since, to them, it seems perfectly rational.
And in a sense, it is rational, given the dearth of alternatives. If nobody wants you at the party, why should you stay? Advocates of Death With Dignity laws who say that patients themselves should decide whether to live or die are fantasizing. Who chooses suicide in a vacuum? We are inexorably affected by our immediate environment. The deck is stacked.
He also notes that there is little evidence of abuse in states that have assisted suicide laws. Perhaps the laws in those states say, as the Massachusetts law says, “there is no requirement for oversight of the ingestion (of poison) at all; no one has to witness how and when the lethal drug is given.” If this is common in such cases, then who would know if there was ever abuse of the law since the chief witness will be dead by the time anyone is around to ask questions?
We have a family member with severely compromised health. She, too, is alive despite all medical prognoses and predictions. She, too, has been near death and doctors and nurses had to fight to have her kept alive. It’s expensive. Something like 80% of the medical expenses anyone will incur in a lifetime accrue during the last months or weeks or days of life through attempts to keep that person alive. If you repeat the process by staying alive, so you can die or almost die again, then you are a real drain on the resources of the health care system. One major reason that health care costs are so high is because medicine can do much to keep the marginally surviving person from dying. It is cheaper to let such people die. And yet….
November 2nd, 2012 | 11:10 am
There is a definite moral difference between assisted suicide and “not taking extraordinary measures to preserve life”. If you ask this of your caregivers, you are merely being realistic about the ultimate result, not trying to anticipate it.
The moral problem comes when the caregiver chooses this alternative on their own, despite the patient’s eagerness to hang on to life. And it is the caregiver’s problem, not the patient’s.
November 2nd, 2012 | 11:22 am
I actually would deny the right of a state to do this, Kate. What about the 14th Amendment? For a time we allowed another fundamental right, “Liberty,” to be decided by states upon entering the union, and that process ended with the Civil War and the passage of the 14th amendment. Here’s what it says:
“nor shall any State deprive any person of life, liberty, or property, without due process of law”
That means state police power regulations of health, safety, and welfare which interfere with those fundamental rights should be void. Now the words “due process” of course has been mangled to no end, and whether it entails life from conception until natural death is the real question. The courts have taken this power onto themselves; personally I think the law isn’t clear enough and there needs to be a Constitutional Amendment definition of life. I think in principle that both Euthenasia and Abortion should be illegal at the Federal level and not even up to the states to decide. It’s also in keeping with the Declaration to protect these fundamental rights. Pragmatically, it might seem better for the states to decide because these are quote-on-quote “hard cases” (hard cases make bad law); I think against euthenasia is actually an easy case since governments should promote and protect the lives of citizens at all times. So I’m not so sure we should let Massachusettes off the hook and allow euthenasia to be something decided by the states.
November 2nd, 2012 | 11:41 am
The state is not making the individual decisions. It is allowing individual decisions to be made by the person whose life is in question, if capable, or those giving care, actual medical people or family and if anyone else, I don’t know about it. People die without any choice. Probably you will or I will and I cannot see how the state could stop that happening. I don’t know that I can equate this with slavery and would note that the legal and social ramifications of government guaranteeing equality has produced profound distortions to our nation’s politics. Not that I would like us to allow slavery by state; how awful it was.
Modern medicine has made this a question for us as it might not have been before. It is a hard question, but to Mr. Marshall’s point, the question is about what are extraordinary measures in any given case. In our case, a medical review board at the hospital, state or federal level might well have determined that the life in question had been extraordinarily expensive over the years and was likely to be more so over time. God knows when the debt will be paid for all of that, but the woman in question has been able to raise the child, the pregnancy of whom was the cause of the medical crisis, for the last six years. It took extraordinary measures to keep her alive. How do you price that?
As an aside, the moral problem of murderers have significant impact on victims.
November 2nd, 2012 | 11:48 am
Kate: I don’t understand why you’re conflating the issues of “extraordinary measures” with assisted suicide? What do these have to do with each other? Not a thing, as far as I can tell.
We wouldn’t condone a gun dealer selling a gun to someone who told him right up front he wanted it to kill himself. That’s what these suicide advocates are pushing, but by pharmacists and doctors instead of gun dealers. This whole “right to die” formulation is despicable and grotesque. If you don’t want medical treatment, then by all means refuse. If you do want medical treatment that you can’t afford to pay for yourself, then the question of who pays and how much comes up. But if you want someone else to kill you, or to “help” you kill yourself, no way no how should society condone that in any way, shape, or form.
November 2nd, 2012 | 12:22 pm
In Ohio it is possible to put a living will on file with your doctor making your wishes known, as well as a copy with whomever you would wish to have durable power of attorney when you are incapacitated. My own is on deposit with the lama of my Buddhist center.
Ask your doctor about these, or the social worker at the hospital. I believe that, in law here, such a living will overrules all other decisions and the default procedure in the medical profession here is to do as much as possible in the absence of one (both from the oath of “do no harm” and the practical consideration of malpractice suits).
November 2nd, 2012 | 12:42 pm
“I see nothing in scripture prohibiting suicide.”
Ms. Pitrone:
There are several statements against suicide in scripture, beginning with the prohibition against murder, and in early Christian tradition, as well.
I understand the desire not to debate the theological. With that said, your broad statement of “nothing in scripture” is incorrect.
November 2nd, 2012 | 12:49 pm
The decision can also be made by anyone with durable power of attorney in the absence of a living will if you are unable to make your wishes known. Only you or a court can assign a DPA, and the court only if it determines that you are incapable of managing your own affairs.
Now this is not the same thing as your insurance (whatever that may be) declining to cover the service, which they may do, even though it exposes them to possible breach of contract suits, depending on how the plan is worded.
But as long as the DPA can show financial responsibility on the part of the patient, the hospital must continue and bill the patient or the estate. The major hospital systems in Columbus, such as Ohio Health offer alternatives for financial hardship cases.
As far as I know, there is no such thing as any independent “medical review board” to make such a decision, though a court may be able to. The only thing that can happen is a termination of coverage by the carrier.
This is all tricky enough that I would urge you to consult with an attorney to guide you through the legal pitfalls.
November 2nd, 2012 | 12:59 pm
Brian, you are quite right that I am making connections that are not theoretically connected. I think they are connected in a practical way through how we think about life and how the disabled or severely ill are treated. Assisted suicide laws as written are not about the healthy, who can kill themselves by whatever means they choose. The ill: Ben Mattlin is discussing people who would die if nothing were done to keep them alive. Read his story. He is addressing the “you don’t want him to suffer” mentality, which can allow death by withholding medical measures or by assisting death with what is or amounts to poison. He is saying he would suffer living with suffering.
November 2nd, 2012 | 1:05 pm
Jonathan, I grant Christian tradition and certainly we must not murder. Show me the scriptures prohibiting suicide. In Romans it says it is better to live and proclaim God than to die and join, which is a rough paraphrase as I only have a couple of minutes to write. The way it is written it is like, “better to give than to receive” which is no prohibition against receiving.
November 2nd, 2012 | 1:34 pm
Kate, Most would argue that from a Biblical/moral standpoint the murder of one’s self is prohibited by the general command against murder. Suicide is a particular type of murder, not a category unto its own. Further, the command to love your neighbor as yourself implies a love for self that would be contrary to suicidal tendencies. But to leave this aside, When the government helps you buy a house, helps you find a job, provides your education, takes care of you when you are sick, protects you from all sorts of bad guys (and big sodas too), pays for your retirement when you are old and pays the person who will change your bum before you die, How dare we say “no the government can’t kill you when you want to die!”
November 2nd, 2012 | 1:41 pm
But what really made medicine so expensive? I would speculate a death spiral (if you will) of reimbursement woes mixed with government regulations and interference.
Medicare reimburses less and less as the years go on, and heath care gets more and more expensive to compensate.
Its hyperinflation gone wild.
November 2nd, 2012 | 4:25 pm
I am reminded of the death of Pope John Paul II. His doctors asked if he wanted pain medication and he refused. Pain, and death, are a necessary part of life. A part of our transition to the next life.
I expect that the sainted Pontiff would not agree with assisted suicide.
November 2nd, 2012 | 8:56 pm
Yes, pain and death are part of life. Death is inevitable and I know people see or appreciate that transition differently. I think of heaven as the greatest of our adventures and truly look forward to it. I know very few other people who think that way.
The difference between murder and suicide is that one is one is an offense against both God and the person murdered. I mean, where does anyone get the nerve to take another person’s life, save in the most violently extreme circumstances, like war or any other variety of self-defense? Suicide, as in the taking of the life, is at most an offense against God and I am not even sure about that. However, the offense against man, in the case of suicide, is about how it leaves the people who are left behind. I don’t just mean family and friends who would be wounded, but the person or persons who had to find and deal with the body that remained. Surely, that is an imposition.
I am not a proponent of suicide, assisted or otherwise. I merely say, as an aside to the real argument in my post, that I see no specific Biblical proscription; though I understand the argument that it could be assumed, roughly as the Trinity must be assumed. We read and reason it in by context. God gives us life as a gift and we do not toss God’s gifts away.
November 2nd, 2012 | 10:54 pm
Kate, my point in mentioning slavery was to show that states can’t just choose to do whatever they want anymore. And a state legalizing certain actions by doctors that until very recently was considered murder is an example of a state doing whatever it wants. Doctors used to follow the principle of the Hippocratic oath (“do no harm”), and that was reflected in state health laws.
P.S. For a good refresher on the “legal logic of Euthenasia” and its connection to “Roe,” see this article by my old mentor, Michael Uhlmann. It’s different than my take: http://www.firstthings.com/article/2007/10/004-the-legal-logic-of-euthanasia-46
November 3rd, 2012 | 6:27 am
“Show me the scriptures prohibiting suicide.”
It seems to me that “Thou shall not kill” would cover that nicely?
November 3rd, 2012 | 7:07 am
I’ve read that the “kill” would be better translated “murder” in the original.
November 3rd, 2012 | 7:15 am
CJ Wolfe, States can do what they like if is there is no federal law that supersedes. Until that time, which I hope never comes, states are on their own, as they once were with abortion. The Uhlmann piece is good. Thank you.
November 3rd, 2012 | 8:13 am
“I’ve read that the “kill” would be better translated “murder” in the original.”
I dunno, but can’t we define suicide as ‘self-murder?’
November 3rd, 2012 | 4:15 pm
The difference between the words kill and murder is merely legal. Murder is the unlawful killing of a person, usually involving forethought and malice.
Were a state to pass legislation legalizing certain ways of or reasons to kill, arguing that such were murder would not be valid. Of course, arguing that constitutional restrictions supersede would be arguable.
The difference is important both in legislation and in scriptural interpretation.
The Law of Moses was given to a homogeneous people. Likely as not the early translators of the Scriptures realized
November 3rd, 2012 | 4:18 pm
“States can do what they like if is there is no federal law that supersedes.”
I don’t understand when this became something that any conservative could say. Rights belong to ME. The individual. The feds can’t take away my rights, or order me around unjustly, and neither can the states, and neither can my local authority. Rights are MINE.
November 3rd, 2012 | 4:32 pm
the danger of using the word murder in translating to various peoples and cultures. A killing of one type might well be legal in one culture while illegal (murder) in another. So, the use of the word kill is more an avoidance of legal verbiage that might be used to attach untrue limits on the application of the Law.
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